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Bed Side Teaching

Affective Disorder
Oleh :
Letchumana Krishnan (P.1411)
Denissri Sundar Murti (P.141)
Prese!tor :
Dr. "aslinda "aunin# S!. K$
PS"%&'A()" D*PA)(M*+(
M*D'%AL ,A%-L(" -+'.*)S'(AS A+DALAS
%ase )e!ort
A male patient aged 19 years, admitted to Dr. M. Djamil hospital on June 16, 2014 with a hie!
omplaint agitated, angry, tal"ing and laughing to himsel! and li"es to #e na"ed sine 2 months
#e!ore entering the hospital. Admitted to hospital !or the !irst time and now is the !irst treatment.
$ame % ni"name & Mr.'
M' & () 1) 4*
+e, & Male
Date o! -irth % Age & Deem#er 1, 1994%19 year
'elationship +tatus & $ot Married
.upation % /duation & $ot wor"ing % +D 0lass 6
'eligion & 1slam
$ationality & 1ndonesian
/thniity & Minang"a#au
Address & Jorong +ungai Jam#u 2eamatan 3ariangan,2a#upaten
4anah Datar.
'+(*)+* S(A(-S
5eneral ondition & A6erage
Awareness & 0omposmentis
-lood pressure & 120%(0 mm7g
7eart rate & 3alpa#le strong, regular, !re8ueny o! (4 times per minute
4emperature & *6.(0 0
'espiration rate & 4hora"oa#dominal, regularly, the !re8ueny o! 20 times
per minute
7eight & 19) m
:eight & 4) "g
-ody shape & $ormal
'espiratory +ystem&
1nspetion & symmetrial le!t and right in a stati state and dynami
3alpation & le!t ; right !remitus
3erussion & resonant le!t and right
Ausultation & #reath sounds 6esiular, no ron"hi, no whee<ing
0ardio6asular +ystem&
1nspetion & 1"tus not 6isi#le
3alpation & 1"tus palpa#le 1 !inger medial =M0+ '10 >
3erussion & 4he #oundary o! heart within normal limits
Ausultation & a pure heart sounds, regular rhythm, no noise
5astrointestinal +ystem&
1nspetion & 4here does not appear to #ulge
3alpation & =i6er and spleen not palpa#le
3erussion & 4impani
Ausultation & #owel ?@A normal
+pei!i disorders & $ot !ound spei!i a#normalities
+*-)OLO/'% S(A(-S
0onsiousness& 50+ 19 ?/4M6>9A
1. +alp neuro ?!i6e sensesA & in normal range
Meningeal sign & 2ernigBs sign negati6e.
1ntraranial pressure sign & no projetile 6omiting, no progressi6e headahe.
CMo6ement & Dree to all diretions
C3ereption & $o diplopia, 6isus not he"ed
C3upil & 1so"or, round, diameter * mm % * mm
C=ight reations & @ % @
C'eation on6ergene & $ot he"ed
C0orneal 'eation & $ot he"ed
C.phthalmosope e,amination & $ot he"ed
11. Motori&
4onus & /utonus
4urgor & normal
3ower & 999 999
999 999
0oordination & good
3hysiologi re!le,&
'e!le,es 'ight =e!t
1. -iseps @ @ @ @
2. 4riseps @ @ @ @
*. 23' @ @ @ @
4. A3' @ @ @ @
3atologi rele,&
-a#ins"y E E
111. +ensi#ility& 4he sensation o! smooth and rough good
1>. >egetati6e !untion& enough meal and sleep,
>. -asi !untion& Ati6ity reading, writing, drawing and ounting an #e done !airly well
>1. +pei!i disorders
'igid & $o
4remor & $o
$asal sti!!ness & $o
.ulogiri" risis & $o
4ortiollis & $o
.ther & $one
=a#oratory in6estigations & ? 1)%06%2014 A
F 7emoglo#in& 19.1 g % dl
F 7ematorit& 49G
F =eu"oytes& 11000%mm*
F 3latelets& 2)1000%mm*
3rotein & @
5luose & C
=eu"oytes & 0C1
/rytroyte & 0C1
0ylinder & C
0rystal & 0aC.,alate
/phitel & @
-iliru#in & C
Hro#ilirogen & @
$ame % age & $el6i $etti % *) years
Address and telephone & Jorong Jam#u 'i6er, 4anah Datar Distrit 3ariangan %
.upation & 7ousewi!e
/duation & +M3
'elationship & Maternal relati6e
1.4he main reason !or patients treated

Agitated, angry, tal" and laugh and lo6e to #e na"ed sine 2 months #e!ore hospital admission.
4reated !or the !irst time.
2.7istory ourse o! the disease&
F 1* April 2014&
3atientIs #eha6ior #egins to hange, angry, restless, tal"ing to himsel!, laughing to himsel! and
li"es to say that he was a magiian and li"es to #e na"ed.3atient laimed he an ontrol anything
with his hand.3atient also #een lit his hands with a igarette #eause patient says it is also
sa!e.3atient o#sessed with igarettes, patients an smo"e a#out 6 pa"s o! igarettes a day and
as" to anyone who met the patient.3atient o!ten gi6es strange pose with his mouth wide open,
his his hands !olded tto #ody.
+ine ill patient su!!ers sleep depri6ation, appro,imately J * hours a day, and poor appetite.
3re6iously patient o!ten 8uarreled with his #rother #eause his #rother is smarter and patient
o!ten !eel negleted at home #y the patient parents.3atient o!ten mo"ed !or stupid.
F June 16, 2014
3atient restless, angry, tal"ing and laughing to himsel! and li"es to #e na"ed sine 2 months
#e!ore entering hospital.3atient !amily #rought patient to -atu +ang"ar 7ospital and re!erred to
the 3syhiatry Department at Dr M Djamil 7ospital, 3adang
*. 3remor#id history
-a#ies & -orn spontaneous, assisted #y midwi6es, #urst into tears, no history o! #lue,
yellow and sei<ures.
0hildren & 5rowth and physial and mental de6elopment in aordane with the hild
similiar age.
4eens & 5rowth in aordane with age, relationships with !riends and the en6ironment
a#out good and patient is a 8uiet #oy.
4. /duational 7istory&
3rimary +hool& up to 9 th grade, do not go to shool #eause it is di!!iult to understand
9. 7istory o! Marriage
3atients were not married
6. /mployment 7istory
3atients do not wor"
). +oioC/onomi 7istory
3atients li6ing with #oth parents who wor"s as a !armer with an inome o! 'p (00 000 perr#ulan
and spending 'p (00,000 per month.
(. Damily Disease 7istory
$ote& 4here are no relati6es o! patients who ha6e the same omplaint with the patient
9. 5raphis ourse o! the disease
2uestion Ans3er 'nter!retation
7ello #rother, my young dotor
Denissri and =ethumana, we
should #rie!ly hatted sisterK
Allowed. good awareness
:hatBs your name KK 'ahmat 0ooperati6e
7ow old are youK
-rother was #orn in what yearK
20 tahun
4ahun 1994,-ulan
Januari,4anggal 2014
.rientation distur#ed
+ister "now now there whereK
:hat hospitalK
Di rumah sa"it
4ida" tahu
.rientation distur#ed
-rother "now how you got hereK 4ahu .rientation distur#ed
:hoIs #rought #rother hereK My dad .rientation distur#ed
Aording to the #rother, you are
si" or notK
$o 1 am mot Disriminati6e insight
7a6e you seen anything unusualK Les a white shadow >isual halluination @
/6er hear the 6oies whispering
to youK
Les Auditori
halluination @
7a6e you smell !ragrant K Les .l!a"tori
7a6e you !elt someone touhed
Les,1 !elt 4atile halluination
."ay,than" you #rother !or your ."ay
time and answer.
+HMMA'L A$D 0.$0=H+1.$+ psyhiatri e,amination
psyhiatri /,amination
'. /eneral Status
Awareness % sensorium & "omposmentis % well
Attitude & ooperati6e
Motor #eha6ior & ati6e
Daial e,pressions & rih
>er#ali<ation and ways o! spea"ing & an spea", 8uite smooth and 8uite learly
0ontat 3syhi & an #e done, !air enough and long enough
Attention & well
1nitiati6e & well
11. +pei!i 0ondition
A. A!!et +tate
1. 0irumstanes a!!eti6e & hipertim
2. /motional li!e
a. +ta#ility & la#il
#. 0ontrol & a ontrolled
. /htCuneht & uneht
d. /in!uhlung & Ade8uate
e. DeepCshallow & deep
!. Di!!erential +ale & narrow
g. Dlow o! emotions & rapid
-. 4he state and !untion o! the intellet
a. Memory & good
#. 0onentration & distur#ed
. .rientation & distur#ed
d. Area o! "nowledge & "nowledge is less
e. Disriminati! insight & distur#ed
!. Alleged intelligene le6el & #elow a6erage
g. Disriminati! judgment & good
h. +et#a" o! intellet & no
0. A#normalities o! sensation and pereption
a. 1llusion & no
#. halluinations
Aoustis & Les
>isual & Les
.l!a"tori" & Les
4atile & Les
D. 4he state o! the proess o! thin"ing
a. 4he speed o! thought proesses& !ast
#. 4he 8uality o! the thin"ing proess
1. 0lear and sharp & less o#6ious and less sharp
2. +ir"umstansial & none
*. 1noherent & Les
4. 7indered & none
9. 7ampered & none
6. Dlight o! ideas & none
). >er#igerasi perserati6e & none
. 4he ontents o! the mind
1. 4he entral pattern in mind& no
2. 3ho#ias & none
*. .#session & Les
4. +uspiion & none
9. Delusions & Les
6. 0on!a#ulation & none
). 7ostility % 6endetta & none
(. Deeling in!erior & Les
9. Muh % little & a little
10. +ense o! sin & no
11. 7ypohondria & none
12. .thers & none
/. A#normalities instintual impulse and ation
1. A#ulia& no
2. +tupor& none
a. 'aptus& none
*. Hproar ommon& none
4. +e,ual De6iation& none
9. /"hopra"sia& none
6. >aga#ondage& no
). 3iromani& none
(. Mannerism& none
9. .thers& none
D. seen o6ert an,iety& noneM
5. 'elations with reality& distur#ed& the #eha6ior, thoughts and !eeling
Multiple A,is 'esume
A,is 1. 4he syndrome 2line
Agitated, angry, tal" and laugh and lo6e to #e na"ed sine 2 months #e!ore hospital admission.
4reated !or the !irst time, and now the pain is pain !irst
5eneral ondition& "omposmentis awareness, ooperati6e, ati6e motor #eha6ior, rih !aial
e,pression, 6er#ali<ation and how to tal" to tal", 8uite smooth and 8uite o#6iously, psyhi
ontats an #e done, !air enough and long enough, no attention, no initiati6e.
spei!i 0ondition
F 4he nature o! !eeling& the sta#ility o! la#ile, handling restrained, uneht, ein!uhlung ade"uat,
deep, narrow di!!erensiasi sale, rapid emotional urrents.
F 0onditions and intelletual !untion& Daya remem#er well, distur#ed onentration, distur#ed
orientation, e,tensi6e "nowledge #elow a6erage, disriminati! 1nsight distur#ed, guess
intelegensia a6erage standard normal, disriminati! good judgment, intelletual #a"wardness
F >ariants o! sensation and pereption& no illusions, halluinations are
F 4he thought proess& !aster, less o#6ious and less sharp.
F Di!!erene instintual impulses and at& 6aga#ondage
F An,ietas seen o6ert& no
F 4he relationship with reality& distur#ed in #eha6ior, thoughts and !eelings
A,is 11. 3ersonality Disorders and Mental 'etardation
3ersonality & Mani 4ype .
Mental 'etardation & none
A,is 111. 5eneral Medial 0onditions
F 4here is no history o! head injury, malaria, typhoid !e6er and a#dominal diseases that re8uire
F $o use o! alohol and drug
A,is 1>. 3syhosoial stressors and /n6ironment
F Always mo"edCtaunted #eause o! his intellet set#a"
F +"ill and ingenuity was always ompared to younger #rother.
A,is > 5lo#al Assessment Duntion 1n
F 4here halluinations or delusions whih in!luene #eha6ior
D1A5$.+1+ .D MH=413=/ AN1+
1 . D*0.2 -ipolar A!!eti6e Disorder the type o! mani episodes with psyhoti symptoms
11. 1ntellet set#a"s
111. 4here is no diagnosis
1>. =ess harmonious relationship with the !amily and o!ten ridiuled in the en6ironment
>. 5AD 21C*0
D1DD/'/$41A= D1A5$.+1+
D.*0.9 Mani episode L44
D.29.0 +hi<oa!!eti6e mani type
D.20.2 +hi<ophrenia "ahtoni"
C 7aloperidol 2 , 1 ta# O 1.9 mg
C >itamin - 0omple, * , 1 O 100 mg ta#
C >itamin 0 * , 1 O 90 mg ta#
'/0.MM/$D/D 4'/A4M/$4
03P 1 ,1 O 100 mg ta#
7aloperidol 2 , 1 ta# O 1.9 mg
473 2 , 1 O 2 mg ta#
>itamin - omple, * , 1 ta#
>itamin 0 * , 1 ta#
Quo ad 6itam & du#ia at #onam
Quo ad !ungsional & du#ia at #onam
Quo ad sosial & du#ia at #onam